The effect of metallic tracheal stents on radiation dose in the airway and surrounding tissues Andrew J. Evans, MD, a,b David Y. Lee, MD, c,d Anudh K. Jain, MD, a,b Syed S. Razi, MD, c,d Koji Park, MD, c,d Gary S. Schwartz, MD, c,d Frieda Trichter, PhD, a,b Jason Ostenson, MS, a,b Jordan R. Sasson, MD, c,d, * and Faiz Y. Bhora, MD, FACS c,d a St. Luke’s-Roosevelt Hospital Center, Department of Radiation Oncology, Albert Einstein College of Medicine, New York, New York b Division of Radiation Oncology, Continuum Cancers Center of New York, New York, New York c St. Luke’s-Roosevelt Hospital Center, Department of Thoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York d Division of Thoracic Surgery, Continuum Cancer Centers of New York, New York, New York article info Article history: Received 3 September 2013 Received in revised form 13 December 2013 Accepted 7 January 2014 Available online 12 January 2014 Keywords: Radiation Airway malignancy Airway obstruction Stents Bronchial malignancy abstract Background: Metallic airway stents are often used in the management of central airway malignancies. The presence of a metallic foreign body may affect radiation dose in tissue. We studied the effect of a metallic airway stent on radiation dose delivery in a phantom and an in vivo porcine model. Methods: A metallic tracheal stent was fitted onto a support in a water phantom. Point dosimeters were positioned in the phantom around the support and the stent. Irradiation was then performed on a linear accelerator with and without the stent. Metallic tracheal stents were deployed in the trachea of three pigs. Dosimeters were implanted in the tissues near (Group 1) and away (Group 2) from the stent. The pigs were then irradiated, and the dose perturbation factor was calculated by comparing the actual dose detected by the dosimeters versus the planned dose. Results: The difference in the dose detected by the dosimeters and the planned dose ranged from 1.8% to 6.1% for the phantom with the stent and 0%e5.3% for the phantom without the stent. These values were largely within the manufacturer’s specified error of 5%. No significant difference was observed in the dose perturbation factor for Group 1 and Group 2 dosimeters (0.836 Æ 0.058 versus 0.877 Æ 0.088, P ¼ 0.220) in all the three pigs. Conclusions: Metallic airway stents do not significantly affect radiation dose in the airway and surrounding tissues in a phantom and porcine model. Radiation treatment planning systems can account for the presence of the stent. External beam radiation can be deliv- ered without concern for significant dose perturbation. ª 2014 Published by Elsevier Inc. All work was performed at St. Luke’seRoosevelt Hospital Center, October 10, 2010 to January 11, 2011. * Corresponding author. Division of Thoracic Surgery, Columbia University College of Physicians and Surgeons, St. Luke’s-Roosevelt Hospital Center, New York, NY. Tel.: þ1212 523 5231; fax: þ1 212 523 2351. E-mail address: josasson@chpnet.org (J.R. Sasson). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research 189 (2014) 1 e6 0022-4804/$ e see front matter ª 2014 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jss.2014.01.013